Patients sometimes ask, “Is fertility treatment painful?” It’s a reasonable question. I know that before I personally undergo any medical procedure, I would want to know that. To better answer this question, I’ve taken an informal survey of my patients who did IVF and asked them to share about their experiences. As can be expected, there were a range of answers. However, the overall agreement, with a few rare exceptions, is that the physical pain associated with their IVF cycle was minimal. By the way, note that we’re talking now only about the physical pain, not the financial and emotional pain (if the cycle fails).
There are several potential sources of pain during an IVF cycle. The first starts out way before the actual egg retrieval. In preparation for the egg harvest, it is standard to take injectable medications to help develop the eggs. These are done with small needles and modern injection pen devices. Almost everyone dreads the first injection just out of fear about the unknown, but after the initial anxiety is over, most women report that the injection pain is nothing. The needles are tiny and go in fast and easy. Compare this to if you had diabetes. In that case, you would be injecting yourself with similar needles many times a day.
The next potential source of pain comes as the eggs develop, when the ovaries start to enlarge, causing bloating. This is a very real phenomenon, and there’s little that can be done about it other than to limit the number of eggs that we grow. Of course, this is a tradeoff, because if you only have 4-5 eggs, the pain and bloating are minimal, but your success rate is going to be decreased. This is the part most women hate, but in reality, most women with a well-controlled stimulation don’t even experience any real pain, but merely significant bloating, which itself can be quite uncomfortable. This discomfort can extend well into the week after the egg retrieval.
The third phase where there could be potential pain comes on the day of the egg retrieval itself. Knowing full well that the eggs are removed by piercing a thin long needle through the walls of the vagina into the ovaries, many women anticipate great pain on that day. But in reality, the pain is zero during the procedure, thanks to the wonders of modern anesthesia. In our program, we have anesthesiologists on hand for every retrieval in order to keep our patients pain-free and breathing normally with normal heart rates and normal blood pressures throughout the case. Some places around the country still do their retrievals without full anesthesia. While this is a cost savings, on the surface, there is a price with regards to patient comfort and the ability to successfully harvest each egg. Way back during my training at UCLA, we used to do these cases under sedation-only and it added to the difficulty of the egg retrieval when patients would occasionally twitch or move. It’s not that hard to aim a needle into a follicle, but it becomes way trickier when your target is moving.
Either three days or five days after the eggs are retrieved, the embryos are transferred back into the uterus. The transfer itself is almost painless, but it is as uncomfortable as a Pap smear.
After the retrieval, patients begin on progesterone, which is an injection, but different from the stimulation medications. Since it is an oil-based injection, the needle is larger and therefore more painful. The opinion on this is variable with some patients reporting a lot of pain while some find it quite tolerable. The ones who really find it unbearable have the option of taking their progesterone in other non-injection forms, such as with vaginal creme or vaginal suppositories.
So in summary, with regards to physical pain, while IVF has the potential to be painful in a few phases, in actuality, there is minimal pain for most patients.
However, nine months later, there is the much greater pain of childbirth and the postpartum period, which far surpasses any pain of the IVF cycle. The consolation is that this great pain is followed by the reward of motherhood 
In addition to the steps you’ve described, some pre-IVF procedures can also be painful, particularly the HSG and the hysteroscopy.
Are the non-injection forms of progesterone as effective as the injectable forms?
It depends on whom you ask. There are some RE’s who will absolutely insist on injectable progesterone as the only choice. There are also some who universally use vaginal progesterone on all their patients. I will use both types depending on the patient’s medical history and her personal preference.
Hello doctor,
Thanks so much for your website, it is so useful, supportive, and entertaining to read!! You could have been just as successful of a writer as you are an RE.
I was wondering if you had time to provide some advice regarding the relationship between acupuncture and IVF success. I’ve already undergone one successful IVF cycle (my son is now 15 months old) and I have my first FET embryo transfer scheduled for Wednesday at 10:30 am. My acupuncturist can see me Tuesday night and Thursday morning, but not on the day of. Everything I’ve googled seems to suggest that acupuncture the day of transfer improves success rates—so I’m not sure if I should try to find a different acupuncturist that would be available on the day of, and/or stick with the one who already knows me (and performed my acupuncture for my previous success). Any thoughts?
Your advice would be so appreciated!!! Thanks again for all that you do, on behalf of all of us reading.
Warmest wishes,
Christina
hi i have had the ivf injection from day two of my cycle the doctor said after injection to have regular intercourse 6 days i hadent pain before but now its 7th day after injection we have stoped the intercourse now i have pain so i dont know have the eggs reliesed or now it is reliesing please help me waiting for replay soon.thanks
Unfortunately for me, my local clinic does not offer anethesia during egg retrieval. I am extremely scared as the HSG was traumatic for me. I was told that the sedation was effective but now I’m worried about twitching and moving, as you mentioned.
Can you give me any advice?
I was crying to the doctor and begging her for anesthesia but she said they don’t believe in it as its dangerous and unessesary.
I’m SO upset.
Aly, I’m guessing that there are no other programs in your area? Best of luck anyway. People have done it successfully both ways, with and without anesthesia.
yes i am thinking about the ivf i dont want any pain going through the whole procedure. my husband and i are trying to concieve with ivf. My specialist informed me that i was a good candidate for ivf i was wondering what is the percentage of twins and triplets, I am very scared of that.
when is the best time to do this befor or during or after my monthly cycle? and will haveing a m/c befor be not a good idea to do this. this is my first time and i would like to know everything about this
hi had ivf treatment i never felt any pain because all the pain was rewarding all i had in my mind was to conceive and now i have a beautiful daughtor , also it depends where u doing the procedure i really trusted the clinic i was with and the doctors.
hi i havnt been able to get pregnant since my termination at 19 im now 25 i have really bad period pain and lot of clots i have a gyni and he sent me for a procedure and found i had right blocked tube he gave me the choice of ivf or clomid 50 mg i thought i would try clomid first after 3 months i have had no sucess but this month i had 8 day early period very painfull but not lot of bleeding do u think it is in my best interest to come off clomid and start the ivf
Doctor:
Since I have the embryo transfer, I have had an abdominal pain 2 inches below the bellybutton. Today is my 10th day and I have a much stronger pain. Is this normal?
I had a cup of coffee this morning. Can caffeine react with my hormones? I am taking progesterone and stradiol (strogens).
Thanks,
Maria
How many days does it take for an ivf circle to be completed
I have had an ectopic pregnancy with right tube amputation in dec 2009, after which i m unable to concieve. I have been on treatment and my HSG and follicle study was done in 2011. I had a failed AIH once and now i want to do IVF. What will be my success rate?? Will it be very painful ??? What are the chances that there will not be ectopic again